Health, Dental, and Life Insurance

Resources

Policies and Procedures:

 

Health Insurance

Eligible employees may enroll in health coverage through the state group insurance program from a choice of two insurance carriers (Blue Cross Blue Shield or Cigna). The available options include:

  • Premier PPO – Highest premiums, but you pay less for copays at the doctor's office and pharmacy than the PPOs and less coinsurance.
  • Standard PPO – Lower premiums than the Premier PPO, but you pay more for copays at the doctor’s office and pharmacy.
  • CDHP/HealthSavings CDHP – Lower premiums and lower out-of-pocket maximum, but you have a higher deductible. You get a HSA — to use for qualified healthcare expenses, including your deductible and to save for retirement. The State puts $500 employee only/$1,000 family tiers* in HSA if eligible (if enrolled prior to September 2nd).

BlueCross BlueShield

NOTE: The information in the PDF directory is only 100% accurate on the day it is printed. It is not uncommon for this information to change as providers and facilities join and leave the carrier's networks. You can find the most up to date information by calling member services or doing an online search.

Cigna 

         NOTE: The information in the PDF directory is only 100% accurate on the day it is printed. It is not uncommon for this information to change as providers and facilities join and leave the carrier's networks. You can find the most up to date information by calling member services or doing an online search.

Member Handbooks

Dental Insurance

Eligible employees can choose from two dental plans:

  • Prepaid Plan
  • Dental Preferred Provider Organization

Cigna - Prepaid Plan

The Prepaid Plan provides services at predetermined copay amounts from a limited network of participating dentists and specialists.

  • To receive benefits, you must select a dentist from the Prepaid Plan list and notify Cigna of your selection. You can search for participating dentists on Cigna's website.
  • There are some areas in the state where the network dentists are not available. Be sure to carefully review the provider directory. Some dental offices may be closed to new enrollment.
  • You must use your selected dentist to receive benefits.
  • The plan provides services at predetermined member copay amounts (reduced fees) for dental treatments.
  • There are no deductibles to meet, no claims to file, no referrals, no waiting period and no annual dollar maximum. Pre-existing conditions are covered.

You can search for participating dentists on Cigna's website — select the Cigna Dental Care HMO network.

Delta Dental - Dental Preferred Provider Organization  

The Dental Preferred Provider Organization (DPPO) provides services with member coinsurance rates. Any dentist may be used to receive benefits, but member cost will be less if an in-network provider is used.

  • Use any dentist (receive maximum benefits when visiting an in-network Delta Dental DPPO provider).
  • Member pays coinsurance for covered services.
  • Deductible applies for basic and major dental care only.
  • You or your dentist will file claims for covered services.
  • Referrals are not required.
  • Some services (e.g. crowns, dentures) require a 6-month waiting period before benefits begin.
  • Other services (orthodontics, replacement of missing tooth) require a 12-month waiting period before benefits begin.
  • There are some limitations and exclusions, (e.g. no benefit for cosmetic reasons, congenital malformations, diagnosis or treatment of TMJ.

You pay coinsurance for many covered services and your share is based on the "maximum allowable charge" (MAC) for a given service. You will pay less out-of-pocket when seeking care from a network provider because network dentists and specialists typically agree to the allowable charge up front. Out-of-network providers typically charge more than the allowable charge, resulting in higher costs for you.

Vision Insurance

EyeMed

Visit eyemed.com/stateoftn to search for an in-network provider near you. Members can register and sign in to their account to view additional resources and discounts.

Pharmacy Program

Your health insurance benefits include pharmacy benefits. This benefit is included for you and all enrolled dependents when you enroll in health insurance. Pharmacy benefits are administered by Caremark.

The state's prescription drug plans require a copay. How much you pay depends on how the prescription is filled.

  • Members pay the lowest amount for a generic (tier one) drug. A generic medicine is FDA approved and equal to the brand name product in safety, effectiveness, quality and performance.
  • Members pay a higher amount for a preferred brand (tier two) drug. Many popular and highly used preferred brands are included on the drug list.
  • Members pay the highest amount for a non-preferred brand (tier three) drug. These belong to the most expensive group of drugs. These drugs are not included on the drug list.
  • CVS Caremark is the pharmacy benefits manager for all plan members regardless of which healthcare option you select.  CVS will mail a welcome packet to all new members with prescription cards for yourself and one for each covered dependent.  Carry this card in addition to your current medical ID card.
     
  • PDF icon CVS Caremark Handbook
  • Caremark Member Home Page

 Life Insurance

Basic Group Term and Basic Accidental Death and Dismemberment Life Insurance

The state pays 100% of the premiums for employee basic term life/basic accidental death and dismemberment insurance for higher education employees.

https://www.tn.gov/partnersforhealth/other-benefits/life.html

  • Basic Term Life: Designated beneficiaries receive 1X the employee’s base annual salary rounded to the next highest thousand ($50K minimum/$250K maximum, except when reduced at age milestones.
  • Basic accidental death and dismemberment: Employee coverage will be 1X basic term life insurance coverage.
  • Basic term life/basic AD&D coverage amounts decrease at ages 65 and over.

Optional Accidental Death and Dismemberment Insurance

Employees can choose optional accident insurance coverage for themselves and their dependents (spouse and children).  This is in addition to their basic accidental coverage.  They pay the full premium for this coverage.  Coverage amount is based on salary and the maximum benefit amount is $60,000 for employees.  Coverage amounts for spouse and children are based on salary and family composition.

Optional Term Life Insurance

  • If you qualify, you may be able to purchase optional coverage from Minnesota Life for yourself and your dependent spouse and children
  • If you are currently enrolled and are eligible for employee guaranteed issues increase, information will be mailed to you.
  • If you and/or your dependent spouse are not presently enrolled, you will be required to present evidence of insurability through a health questionnaire.
PDF icon Securian Life Insurance Handbook